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PURPOSE The ICRU has published new recommendations for ionizing radiation dosimetry. In this work, the effect of recommendations on the water-to-air and graphite-to-air restricted mass electronic stopping power ratios (sw, air and sg, air ) and the individual perturbation correction factors Pi was calculated. The effect on the beam quality conversion factors kQ for reference dosimetry of high-energy photon beams was estimated for all ionization chambers listed in the Addendum to AAPM's TG-51 protocol. METHODS The sw, air , sg, air , individual Pi, and kQ were calculated using EGSnrc Monte Carlo code system and key data of both ICRU report 37 and ICRU report 90. First, the Pi and kQ were calculated using precise models of eight ionization chambers: NE2571 (Nuclear Enterprise), 30013, 31010, 31021 (PTW), Exradin A12, A12S, A1SL (Standard imaging), and FC-65P (IBA). In this simulation, the radiation sources were one 60 Co beam and ten photon beams with nominal energy between 4 MV and 25 MV. Then, the change in kQ for ionization chambers listed in the Addendum to AAPM's TG-51 protocol was calculated by changing the specification of the simple-model of ionization chamber. The simple-models were made with only cylindrical component modules. In this simulation, the radiation sources of 60 Co beam and 24 MV photon beam were used. RESULTS The significant changes (p

Purpose The International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have jointly published a new code of practice (CoP), TRS483, for the dosimetry of small static photon fields used in external beam radiotherapy. It gave recommendations on how to perform reference dosimetry in nonstandard machine-specific reference (msr) fields and measure field output factors in small fields. The purpose of this work was to perform a dosimetric evaluation of the recommendations given in this CoP. Methods All measurements were done in a Varian TrueBeam™ STx linear accelerator. Five ionization chambers were used for beam quality measurements, four Farmer type ionization chambers for performing reference dosimetry and two diodes for performing field output factor measurements. Field output factor measurements were done for fourteen field sizes (ranging from 0.5 cm × 0.5 cm to 10 cm × 10 cm). Beam energies used were: 6 MV WFF, 6 MV FFF, 10 MV WFF, and 10 MV FFF. Where appropriate, results from this study were compared with those obtained from the recommendations given in the IAEA TRS398 CoP, AAPM TG51 and TG51 Addendum protocols. Results Beam quality measurements show that for all beam energies and for equivalent square msr field sizes ranging from 4 cm × 4 cm to 10 cm × 10 cm, agreement between calculated and measured values of TPR20,10 (10) was within 0.6%. When %dd(10,10)X was used as beam quality specifier, the agreement was found to be within 0.8%. Absorbed dose to water per unit monitor unit at the depth of maximum dose zmax in a beam of quality Q, Dw,Qzmax/MU, was determined using both %dd(10,10)X and TPR20,10 (10) as beam quality specifiers. Measured ratios of Dw,Q (zmax )/MU, determined using the two approaches, ranged between 0.999 and 1.000 for all the beam energies investigated. Comparison with TRS398, TG51 and TG51 addendum protocols show that depending on beam energy, the mean values of the ratios TRS398/TRS483, TG51/TRS483, and TG51 Addendum/TRS483 of Dw,Q (zmax )/MU determined using both approaches show excellent agreement with TRS398 CoP (to within 0.05%); agreement with TG51 and TG51 addendum was to within 0.3% for all four beam energies investigated. Field output factors, determined using the two methods recommended in the TRS483 CoP, showed excellent agreement between the two methods. For the 1 cm collimator field size, the mean value of the field output factor obtained from an average of the two detectors investigated was found to be 2% lower than the mean value of the uncorrected ratio of readings. Conclusion For beams with and without flattening filters, the values of Dw,Q (zmax )/MU obtained following the new CoP are found to be consistent with those obtained using TRS398, TG51 and TG51 addendum protocols to within 0.3%. Field output factors for small beams can be improved when the correction factors for different detectors included in TRS483 are appropriately incorporated into their dosimetry.

Purpose: The working group on the review and extension of the TG-51 protocol (WGTG51) collected data from American Association of Physicists in Medicine (AAPM) members with respect to their current TG-51 and associated addendum usage in the interest of considering future protocol addenda and guidance on reference dosimetry best practices. This study reports an overview of this survey on dosimetry of external beams. Methods: Fourteen survey questions were developed by WGTG51 and released in November 2015. The questions collected information on reference dosimetry, beam quality specification, and ancillary calibration equipment. Results: Of the 190 submissions completed worldwide (U.S. 70%), 83% were AAPM members. Of the respondents, 33.5% implemented the TG-51 addendum, with the maximum calibration difference for any photon beam, with respect to the original TG-51 protocol, being

Purpose: Japan Standard Dosimetry of Absorbed dose to water in external beam radiotherapy (JSDP12) is widely used to measure radiation dose in radiotherapy. However, JSDP12 does not take flattening-filter-free (FFF) beam into consideration. In addition, JSDP12 applied TPR20,10 for dose quality index for photon beam. The purpose of this study is to compare JSDP12 with AAPM TG-51 addendum in order to establish optimal dosimetry procedure for FFF beam. Method: We evaluated the ion-recombination factor (ks) and the correction factor of radial beam profile (Prp) in FFF beam dosimetry. The ks was introduced by 2 voltages method and verified by Jaffe's plot. The Prp was given by both film measurement and calculation of treatment planning system, and compared them. Next, we compared the dose quality indexes (kQ) between TPR20,10 method and PDD(10)x method. Finally we considered optimal dosimetry protocol for FFF photon beam using JSDP12 with referring TG-51 addendum protocols. The FFF photon beams of 6 MV (6X-FFF) and 10 MV (10X-FFF) from TrueBeam were investigated in this study. Results: The ks for 6X-FFF and 10X-FFF beams were 1.005 and 1.010, respectively. The Prp of 0.6 cc ionization chamber for 6X-FFF and 10X-FFF beams (Film, TPS) were (1.004, 1.008) and (1.005, 1.008), respectively. The kQ for 6X-FFF and 10X-FFF beams (JSDP12, TG-51 addendum) were (0.9950, 0.9947) and (0.9851, 0.9845), respectively. The most effective factor for uncertainty in FFF photon beam measurement was Prp for JSDP12 formalism. Total dosimetric differences between JSDP12 and TG-51 addendum for 6X-FFF and 10X-FFF were -0.47% and -0.73%, respectively. Conclusion: The total dosimetric difference between JSDP12 and TG-51 addendum was within 1%. The introduction of kQ given by JSDP is feasible for FFF photon beam dosimetry. However, we think Prp should be considered for optimal dosimetry procedure even if JSDP12 is used for FFF photon beam dosimetry.

Purpose: To quantify differences between the TG51 and TG51 addendum calibration protocols. Methods: Beam energies of 6X, 6XSRS, 10X, 15X, 23X, 6XFFF, and 10XFFF were calibrated following both the TG51 and TG51 addendum protocols using both a Farmer and a scanning ionization chamber with traceable absorbed dose-to-water calibrations. For the TG51 addendum procedure, the collimating jaws were positioned to define a 10×10cm2 radiation field, a lead foil was only used for kQ measurements of FFF energies, and a volume-averaging correction was applied based on crossline and inline dose profiles. For the TG51 procedure, the collimating jaws were set to 10×10cm2 according to the digital readout, and a lead foil was used for kQ measurements of energies greater than 10MV. Results: For beam energies with a flattening filter, absorbed dose-to-water determined by the two protocols differed by 0.1%–0.3%. For FFF beam energies, differences between the protocols were up to 0.2% and 0.8% for the scanning and Farmer ionization chambers, respectively. Differences between the protocols were due to kQ determination, volume-averaging correction, and measurement of raw ionization. Differences in kQ values between the two protocols were up to 0.4% and 0.2% for the scanning and Farmer ionization chambers, respectively. Volume-averaging corrections were less than 0.1% for the scanning ionization chamber, and up to 0.4% and 0.6% for the Farmer ionization chamber in beams with a flattening filter and FFF beams, respectively. Raw ionization measurements differed up to 0.3%±0.07% due to differences in jaw settings. Conclusion: The TG51 and TG51 addendum calibration protocols differed less than 0.3% for the scanning ionization chamber. For the Farmer chamber in FFF energies, volume-averaging corrections of up to 0.6% contributed to calibration differences of up to 0.8%. Failure to verify the radiation field size can produce calibration differences of up to 0.3%.

Purpose: Several clinical reference dosimetry protocols for absorbed-dose to water have recently been published: The American Association of Physicists in Medicine (AAPM) published an Addendum to the AAPM’s TG-51 (Addendum TG-51) in April 2014, and the Japan Society of Medical Physics (JSMP) published the Japan Society of Medical Physics 12 (JSMP12), a clinical reference dosimetry protocol, in September 2012. This investigation compared and evaluated the absorbed-dose to water of high-energy photon beams according to Addendum TG-51, International Atomic Energy Agency Technical Report Series No. 398 (TRS-398), and JSMP12. Methods: Differences in the respective beam quality conversion factors with Addendum TG-51, TRS-398, and JSMP12 were analyzed and the absorbed-dose to water using 6- and 10-MV photon beams was measured according to the protocols recommended in Addendum TG-51, TRS-398, and JSMP12. The measurements were conducted using two Farmer-type ionization chambers, Exradin A12 and PTW 30013. Results: The beam quality conversion factors for both the 6- and 10-MV photon beams with Addendum TG-51 were within 0.6%, in agreement with the beam quality conversion factors with TRS-398 and JSMP12. The Exradin A12 provided an absorbed-dose to water ratio from 1.003 to 1.006 with TRS-398 / Addendum TG-51 and from 1.004 to 1.005 with JSMP 12 / Addendum TG-51, whereas the PTW 30013 provided a ratio of 1.001 with TRS-398 / Addendum TG-51 and a range from 0.997 to 0.999 with JSMP 12 / Addendum TG-51. Conclusion: Despite differences in the beam quality conversion factor, no major differences were seen in the absorbed-dose to water with Addendum TG-51, TRS-398, and JSMP12. However, Addendum TG-51 provides the most recent data for beam quality conversion factors based on Monte Carlo simulation and greater detail for the measurement protocol. Therefore, the absorbed-dose to water measured with Addendum TG-51 is an estimate with less uncertainty.

The addendum to TG‐51, which is currently under review, will provide an expanded new set of beam quality conversion factors, kQ. The calculated values of kQ in the TG‐51 protocol are based on analytic calculations which make use of various tabulated values of measured and calculated factors uch as the water to air stopping‐power ratio, Pwall, Prepl and Pcel (for details see Ch 9 of the 2009 AAPM Summer School book, Med. Phys. Publishing, Madison, WI). However, with the development of the EGSnrc Monte Carlo system (Kawrakow, Med Phys 27(2000) 499) it is possible to accurately calculate the response of ion chambers. Also computers have became faster per unit cost and clever variance reduction techniques have been implemented for doing ion chamber calculations in complex geometries (Wulff et al, Med Phys 35(2008)1328). Hence ab initio Monte Carlo calculations of kQ have become both accurate and feasible using large clusters of computers. Values of kQ have been calculated this way for a total of 33 commonly used cylindrical ion chambers (Muir and Rogers, Med Phys 37(2010)5939) and these kQ values are accurately fit as a quadratic function of the beam quality specifier, %dd(10)x. Detailed estimates of the systematic uncertainty in these calculations have been made and range between 0.6% and 1.0%, depending on the assumptions made. The largest component is the uncertainty (previously 0.5%) in the assumed constancy with beam quality of (W/e)air, which relates the energy deposited in the cavity to the charge released in the air.In a detailed comparison of the calculated kQ values to the extensive high‐quality measurements by McEwen (Med Phys 37(2010)2179), Muir et al (Med Phys 38 (2011) 4600) found the mean percentage differences between the calculations and the experiments are 0.08(0.17), 0.07(0.32) and 0.23(0.31) in 6, 10 and 25 MV beams respectively (bracketed values are rms deviations). These discrepancies are well within the stated uncertainties of the measurements (about 0.3% to 0.4%) and the calculations (about 0.3% to 0.4% ignoring W/e uncertainties and assuming correlated uncertainties in photon cross section). These and similar comparisons for plane‐parallel chambers (Muir et al, Med Phys 39(2012) 1618) can be used to set an upper limit of 0.36% on the variation of (W/e)air with beam quality between 60Co and 25 MV beams (95% confidence). More importantly, the close agreement with experiment gives confidence in the accuracy of the Monte Carlo calculated values of kQ with a 68% confidence uncertainty of between 0.4% and 0.5%.The addendum to TG‐51 recommends use of these calculated values of kQ for the 21 ion chambers which meet the requirements for a reference class ion chamber. Learning Objectives 1. To become aware of the new addendum to TG‐51 regarding reference dosimetry in photon beams. 2. Understand how ab initio calculations of the TG‐51's beam quality conversion factor, kQ, are done 3. Understand the uncertainties involved in ab initio calculations of kQ.

This presentation will describe the new addendum to the AAPM's TG‐51 protocol covering photon beam reference dosimetry, which is in the final stages of review and will be published in 2012. The addendum does not hange either the formalism of TG‐51 or the standard reference conditions (i.e., 10 cm × 10 cm field at 1 m) but provides new chamber‐specific data together with detailed guidance on the relevant factors to take into account when following the TG‐51 protocol. The presentation will review the addendum in some detail with particular focus on: 1) Best practice recommendations to minimize errors and ensure consistent dosimetric reporting, including choice of chamber, experimental procedures, determination of correction factors, and application to FFF linacs.2) An in‐depth discussion of uncertainties with guidance on how the clinical physicist can affect the overall uncertainty in the determination of absorbed dose to water Learning Objectives: 1. Understand the scope of the TG‐51 addendum or photon beam dosimetry. 2. Understand how the addendum should be implemented to achieve the highest level of accuracy. 3. Understand how to construct an uncertainty budget for the determination of dose at the reference point and how the clinical user can influence the overall value of uncertainty.

Tables II, III, and IV in this article should be updated with information recently published in Report No. 116: Limitation of Exposure to Ionizing Radiation, National Council on Radiation Protection and Measurements, Bethesda, MD (1993). Updated Tables II, III, and IV were provided to Medical Physics in the early fall, but were not included in the printed review. The updated tables are presented here.

The identification of water-equivalent material used in the title publication is given to be model No. 451 manufactured by Radiation Materials, Inc. (RMI). New data is presented for solid water model No. 457.(AIP)